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Author
Topic: Do I understand the process well? (Read 4701 times)

My tcells are 432, my viral count is 54000 and this is my first lab test result after I found I was tested positive.

What we want to see in the next test is a lower tcell count, but not dramatic, something like 360-370, coming from 432. The virus will win in the long term, there are very rare cases where the virus loses, so we expect a lower tcell count. But we also want the viral load to go down to "undetectable", that is under 100, which is possible without medication, but difficult if not impossible to achieve without medication. A viral load under the current count of 54000 will be great news. We don't want to see the viral load going up and the tcells going down, that would mean that my body is not strong enough to fight it.

What happens from what I understand it is this:

1) after initial infection, the virus thinks about it for a couple of weeks or months, then is happy it found someone it liked and goes completely mad, it reproduces itself like crazy, and the immune system takes some time to respond. This is when the flu symptoms occur, and body rash, and thank God I had those symptoms which made me see the doctor and ask for the hiv test pretty early. Those flu symptoms were the "seroconversion" process. If the timing is correct I got infected mid december, and got the seroconversion end january when I then took the test.

2) Then the tcells start attacking the virus, as a normal infection war, and some die in the process, the viral load goes from down from millions to thousands in this war. According to my doctor that's where I am; let's say my normal tcell count is 800, I've lost half of them, and the virus lost millions, so I win for now.

Then there is a stabilization process, where the body tries to figure out what the fuck is going on, and the virus tries to get control and mutate to avoid the tcells killing it. At the same time it bonds into healthy tcells and converts them into attackers. This is the process that takes years, and when the virus finally takes over all of the tcells, which is about a 10 years process, it wins and there is no immunity left, and you can just die of a simple cold. Currently, the avg time for that process to happen without medication is about 10 years.

Medication fixes two things: one type makes the tcell "slippery" so the hiv virus cannot bond to it. The other type makes the hiv virus kill itself by confusing it when it's trying to transform a tcell into an attacker.

If there is no medication, the virus wins all the time.

From what I can read, it looks like physicians prefer to let the body deal with it and see how it reacts then start medication when the number of tcells are too low to avoid other infections being fought correctly. That number seems to be 350 tcells per sample. If the number of tcells goes below 350 then they usually start medication to help the system.

However, if the viral load was growing in the next test but the tcell count was staying the same or lowering, medication would be started too. It's basically a decision of what is the fighting priority, hiv or other potential viruses. Now the interesting thing is that hiv is not a disease in itself, you don't die of hiv virus like you could die of hep-C. hiv is different because it kills your immune system, whereas other viruses don't kill it but are so virulent the immune system can't deal with them.

I think you have an understanding but mis-spoke when you said you wanted a lower tcell count. You never want a lower tcell count unless you're maybe in the 1,500 range...very unlikely.

You'll see varying figures on what is a "normal" tcell count. It's impossible to know what is "normal" for you at this point. You'd have to have counts done prior to infection. Most of the literature says between 500 and 1,000 is normal. 350 is the break off point. And I believe starting meds earlier than later offers the best response, i.e. don't just keep letting them drop all the way down to 200.

Your VL is moderate. As an early infection you should see it drop and your tcells will probably jump up. But it's different for everyone. Just know the meds are there if you need 'em.

I find the "normal" tcell count a bit confusing. 500-1500 is accepted as a "normal" count. If my count is 432 then I would think that i'm reasonably "a bit low" compared to 500, but "seriously low" compared to 1500. I looked around and I can't find any "t cell count average" for the non-hiv positive population. Is there such a number available?

But we also want the viral load to go down to "undetectable", that is under 100, which is possible without medication, but difficult if not impossible to achieve without medication. This is the process that takes years, and when the virus finally takes over all of the tcells, which is about a 10 years process, it wins and there is no immunity left, and you can just die of a simple cold. Currently, the avg time for that process to happen without medication is about 10 years.

If there is no medication, the virus wins all the time.

From what I can read, it looks like physicians prefer to let the body deal with it and see how it reacts then start medication when the number of tcells are too low to avoid other infections being fought correctly. That number seems to be 350 tcells per sample. I am understanding the process correctly?

Hi. I like the way you wrote this, because it's a good method to gain the best understanding.

Forgive me for only commenting where we might have tentative disagreements---especially since my view is a bit more optimistic than yours [I HAVE ONLY KEPT YOUR QUOTES FOR THE PORTIONS I WILL COMMENT ON].

1) When I quit my meds (STI) in 2002 my VL did rise, I believe to 14,000. That got me pretty worried. But it then went down, all over the place generally between 1-4,000. Incredibly, around the end of the first year and the first half of the second year of non-treatment, my VL was UNDETECTABLE. I think I had three readings that gave me the astounding good news. Those numbers are long gone (see my Point 2), but I am doing OK, about 5 years later.

2) Without medication ever, a person will most likely die from an OI caused my an immune system devastated by HIV. But not everyone... And maybe not as soon as you suggest...[/i]Some people, probably due to genetic make up are LTNPs, Long Term Non-Progressors. They aren't all chaste goody-two-shoes eating restricted diets. There is a multi-year study in San Francisco of POZ men who 1) admit to using hard drugs for years on end, over more than the last ten years 2) are sexually active with many partners 3) have unprotected sex hundreds or thousands of times at least 1/2 the years of the study. These guys are the very few lucky ones; LTNPs. I am not recommending their lifestyle as a path to good health. But the science is amazing! It seems "without medication the virus doesn't win all the time."

Now, since LTNPs probably aren't 1% of the population, how about the rest of us? I have been without treatment for 11 of 16 years. I show no signs of being near mortality. My (6 year untreated) VL is now 50,000 or higher. While I am not happy with that, it is still awfully low. My t-cells declined without treatment, finally to about half. But they're 400, not 300 or lower. I am not a LTNP, but I am something pretty lucky. Lots of people fall into my group. Genetic? Maybe. I am grateful. In my case...the meds work...and my body does pretty well against hiv without the meds. So well, the question good be posed whether I benefited in the long run from taking meds when I did. I don't have an answer. The 10 year thing just doesn't apply. In fact, I honestly expect to reach the beginning of old age (ie, 65, 75), and maybe have heart disease or some cancer to worry about.

3) If your t-cell #s fall below 300 (some say higher, like your "350") and/or your VL climbs over 100,000 parts/ml, it's time for meds. Notice the "and/or". The VL is a also a determinate. . In my case, I expect to reach either threshold soon (this year or next), and start new meds.

4) Though you didn't quite touch on the issue of mortality rates for treated people, I hope you realize that the death rates for POZ plummeted many years ago and remain a fraction of the peak in the 1980s/early 1990s. Lots of very sick people are living a long, long, time. A number of them are on this Site typing away offering lots of wisdom (because they have been through so much). All my very sick and less ill POZ friends who made it through 1995 are still here----no exceptions. Since you consider that many people are living with old infections (people sick the longest period are generally closer to mortality) this is statistically very significant.

The picture is less bleak than you may believe. There are plenty of rational reasons to have hope. My 2 cents, anyway. -megasept

Most of the literature I've read says 500-1000 is a normal tcell count. I would assume that is based on various studies. Not everyone's immune system is exactly the same, thus the wide variable in what is a normal tcell count and the wide variable in how we all respond to HIV. What you'll find much more important than a single number is trends over time. You probably won't have a clear picture to what is going on until two more lab tests from now. The trends over 9 months will be alot more informative than one snapshot. All you know right now is that you're okay and will probably continue to be fine in the near future. And if the trends go in the wrong direction...there is medicine to change that direction.

All of the above + one more thing: you should also be aware of your CD4/CD8 ratio. The ratio in a healthy person is 1:1, when the CD4 drop the ratio drops, and that is also telling. For example, someone here mentioned they have a CD4 above 400 with a 25% ratio; mine is around 200 with a 30% ratio (up from initial 10%), meaning my optimum 100% is around 700 Cd4s. I suppose - please someone correct me if I am wrong - that the ratio and not the absolute number determines the body's ability to ward off disease.

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"If you keep one foot in yesterday, and one in tomorrow, you piss all over today". Betty Tacy

Hi Dragonette I think your quote below has some wrong information. I'm copying the following text from the AIDSmeds Lessons section and coloring it blue: The T-Cell Ratio. The T4 Count divided by the T8 Count. Since the T4 count is usually lower than normal in people living with HIV, and the T8 count is usually higher, the ratio is usually much lower than normal. A normal ratio is usually between 0.9 and 6.0. Like the T8 cell count, nobody really knows what this low number means. However, most experts agree that once anti-HIV therapy is started, an increase in the T-cell ratio (i.e. a rising T4 count and a falling T8 count) is a tell-tale sign that drug treatment is working.

All of the above + one more thing: you should also be aware of your CD4/CD8 ratio. The ratio in a healthy person is 1:1, when the CD4 drop the ratio drops, and that is also telling. For example, someone here mentioned they have a CD4 above 400 with a 25% ratio; mine is around 200 with a 30% ratio (up from initial 10%), meaning my optimum 100% is around 700 Cd4s. I suppose - please someone correct me if I am wrong - that the ratio and not the absolute number determines the body's ability to ward off disease.

Thanks for the correction! Then it is better than I actually thought... if the normal ratio is 0.6-0.9 and not 1:1, so 0.3 isn't that bad, and can be actually equivalent to 0.5 on the low end.........

What i noticed also, the CD8 number isn't fixed, and can change. I am white cell anemic (those are CD8s right?), and that changes too from time to time, so we always have to know the CD4, CD8, and the ratio, to know how good we're doing.

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"If you keep one foot in yesterday, and one in tomorrow, you piss all over today". Betty Tacy